High-dose therapy followed by autologous purged stem cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by the GOELAMS with final results after a median follow-up of 9 years.
Autologous stem cell transplantation (ASCT) as first-line therapy for follicular lymphoma (FL) remains controversial. The multicenter study randomized 172 patients with untreated FL for either immunochemotherapy or high-dose therapy (HDT) followed by purged ASCT. Conditioning was performed with total body irradiation (TBI) and cyclophosphamide. The 9-year overall survival (OS) was similar in the HDT and conventional chemotherapy groups (76% and 80%, respectively). The 9-year progression-free survival (PFS) was higher in the ASCT than the chemotherapy group (64% vs 39%; P = .004). A PFS plateau was observed in the HDT group after 7 years. On multivariate analysis, OS and PFS were independently affected by the per-formance status score, the number of nodal areas involved, and the treatment group. Secondary malignancies were more frequent in the HDT than in the chemotherapy group (6 secondary myelodysplastic syndrome/acute myeloid leukemia and 6 second solid tumor cancers vs 1 acute myeloid leukemia, P = .01). The occurrence of a PFS plateau suggests that a subgroup of patients might have their FL cured by ASCT. However, the increased rate of secondary malignancies may discourage the use of purged ASCT in combination with TBI as first-line treatment for FL. This trial has been registered with ClinicalTrials.gov under identifier NCT00696735.
Gyan
Emmanuel
E
Department of Hematology, Bretonneau University Hospital, Tours, France.
Foussard
Charles
C
Bertrand
Philippe
P
Michenet
Patrick
P
Le Gouill
Steven
S
Berthou
Christian
C
Maisonneuve
Hervé
H
Delwail
Vincent
V
Gressin
Rémi
R
Quittet
Philippe
P
Vilque
Jean-Pierre
JP
Desablens
Bernard
B
Jaubert
Jérôme
J
Ramée
Jean-François
JF
Arakelyan
Nina
N
Thyss
Antoine
A
Moluçon-Chabrot
Cécile
C
Delépine
Roselyne
R
Milpied
Noël
N
Colombat
Philippe
P
Deconinck
Eric
E
D000293:Adolescent; D000328:Adult; D016465:Bone Marrow Purging; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008224:Lymphoma, Follicular / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D016609:Neoplasms, Second Primary / Q000401:mortality*; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
D019653:Myeloablative Agonists; D003520:Cyclophosphamide